Predicting delays in lung cancer diagnosis and staging

Abstract

Background: Despite growing interest in increasing the efficiency and speed ofthe diagnosis, staging, and treatment of lung can cer (LC), the interval from signsand symptoms to diagnosis and treatment remains longer than recommended.The aim of this study was to analyze the factors that cause delays in the LC diag-nosis/staging process and, consequently, delays in makin g therapeutic decisions.Methods: We analyzed audit data from a prospective dataset of 1330 patientsassessed at The Lung Cancer Rapid Diagnostic Unit from 26 June 2013 to26 March 2016. The number and type of procedures and medical tests and thetimes of all procedures were recorded. Clinical and epidemiological variables andwhether the diagnosis was performed on an inpatient or outpatient basis werealso recorded.Results: Malignancy was confirmed in 737 (55.4%) of the 1330 patients, with LCin 627 of these (85.2%). The mean interval to final diagnosis was19.8  13.9 days. Variables significantly related to a longer diagnostic time werethe number of days until computed tomography (CT) was performed (odds ratio[OR], 95% confidence interval [CI] 1.347, 1.103–1.645; P = 0.003), until a histol-ogy sample was obtained (OR 1.243, 95% CI1.062–1.454; P = 0.007), and thetotal number of tests performed during the diagnostic and staging process(OR 1.823, 95% CI 1.046–3.177; P = 0.03).Conclusions: A greater number of tests and more days to CT and histology ledto longer delay times. Optimization of these factors should reduce delays in theLC diagnosis process.